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Behavioral health is an overarching term that includes treatment for “mental health and substance abuse conditions, life stressors and crises, stress-related physical symptoms, and health behaviors.”¹⁸ It is estimated that up to 70% of primary care visits are driven by behavioral health–related issues,¹⁹ and if untreated, these issues can exacerbate or cause physical health problems. Unfortunately, shortages of mental health professionals, particularly in rural areas; lack of insurance coverage for behavioral healthcare services; high out-of-pocket costs for care; and stigma can make it difficult for people to access the behavioral healthcare they need.^20,21

Behavioral health integration is when medical and behavioral health clinicians work as a team to care for patients within a primary care setting.¹⁸ Evidence suggests that providing comprehensive behavioral healthcare within primary care settings leads to improved care and reduced costs.²² The American Medical Association reports that it is essential for primary care practices to accelerate behavioral health integration to help address unmet behavioral healthcare needs.²³ 

In addition to funding primary care research grants to understand issues related to behavioral health and behavioral health integration, described below, ������Ƶprovides data to quantify behavioral health challenges and provides tools and resources to support clinicians with screening and treatment.

Grants

Across AHRQ primary care research grants with active funding in FYs 2023 and 2024, 10 focus mainly on behavioral health and substance use disorders (SUDs). This includes five R18 grants (Research Demonstration and Dissemination Projects), two R01 grants (Research Projects), one R03 grant (Small Research Projects), one K01 grant (Research Career Programs), and one R36 award (Dissertation Grants). 

One additional grant has some focus on behavioral health and is described in the Person-Centered Care section. 

We summarize the 10 grants focused on behavioral health and SUDs below, organized by subtopic. The three subtopics are:

• Substance Use Disorders.
• Behavioral Health Integration.
• Behavioral Approach to Treating Chronic Pain. 

Substance Use Disorders

These five grants examine ways to treat or provide support for people with SUDs, including opioid use disorder (OUD). Four of the five grants were funded through a request for applications (RFA) called .

(R18) 
PI: Tyler S. Oesterle 
Organization: Mayo Clinic Rochester 
Grant Start Date: September 30, 2023 
Develops an integrated behavioral health collaborative care platform using the Senyo Health app to deliver screening, brief intervention, and referral to treatment (SBIRT) for SUDs in primary care. This grant is part of the  grant initiative. 

(R18) 
PIs: Neera Goyal; Vanessa L. Short 
Organization: Nemours Children’s Hospital, Delaware  
Grant Start Date: April 1, 2020 
Looks at the use of comprehensive group well-child visits for mothers with opioid use disorder and their children. The group visits examined in this study allow for increased time with the pediatrician, peer-to-peer learning, and an enhanced focus on behavior change and self-care.

Learn more about this study in a recent NCEPCR webinar: Qualitative Methods Used in ������ƵFunded Primary Care Research

(R18) 
PIs: Babak Tofighi; Helen-Maria Lekas; Crystal Fuller Lewis  
Organization: Friends Research Institute, Inc.  
Grant Start Date: September 30, 2023 
Examines the effectiveness of a previously developed artificial intelligence (AI)–driven texting tool to facilitate buprenorphine treatment through primary care for Black and Latino people who use opioids. The tool uses natural language processing to facilitate real-time text responses to patient queries (without requiring real-time staff engagement), combined with automated texts. The study conducts a three-arm, comparative effectiveness trial comparing text-based care coordination for people who use opioids along with AI-driven social determinants of health (SDOH)-enhanced text messaging (intervention arm-1) vs. AI-driven SDOH-enhanced text messaging only (intervention arm-2) vs. usual care including printed social services and clinical referrals (usual care arm). The research team also conducts a comprehensive economic evaluation to compare the relative economic value of each approach. 

This grant is part of the  grant initiative. 

(R18) 
PI: Sebastian Tong 
Organization: University of Washington  
Grant Start Date: September 30, 2023 
Develops and tests a change package of interventions to treat unhealthy substance use. Participating primary care practices join a learning collaborative where they receive support to implement their selected intervention from the change package. The research team evaluates the practices' implementation outcomes and conducts qualitative interviews to gather data on patient functioning, unhealthy substance use, recovery, process outcomes, and healthcare utilization. 

This grant is part of the  grant initiative. 

(R18) 
PI: Daniel E. Jonas 
Organization: Ohio State University  
Grant Start Date: September 30, 2023 
Aims to improve screening for and management of substance use disorders in primary care. The trial tests whether practice facilitation can achieve rapid implementation of patient-centered outcomes research findings. It also tests whether learning collaboratives, performance incentives, or a combination of the two can significantly improve the implementation of screening for and management compared with practice facilitation alone. 

This grant is part of the  grant initiative.

Behavioral Health Integration 

The four grants described below examine various approaches for integrating primary care and behavioral health. 

(R03) 
PI: Arik V. Marcell 
Organization: Johns Hopkins University  
Grant Start Date: April 1, 2023 
Aims to understand the benefits of preventive care about substance use for adolescents in primary care using the National Institutes of Health NEXT Study data. Specifically, the study seeks to understand the extent to which substance-using adolescents participate in well-visits, the proportion of adolescents who are asked and advised annually about substance use at well-visits, and the extent to which being asked and advised about substance use during adolescence is related to the prevention of future substance use initiation or reduction of substance use over time. 

(R36) 
PI: Meagan J. Sabatino 
Organization: University of Massachusetts Medical School – Worcester  
Grant Start Date: August 1, 2024 
Examines the impacts of integrated social and healthcare services on the experiences and outcomes of patients with behavioral health conditions in Massachusetts' Medicaid program (MassHealth). The research team conducts qualitative interviews to identify barriers and facilitators to effective care delivery and understand patients’ experiences; conducts a cross-sectional analysis with survey and MassHealth administrative data to examine the relationship between primary care clinicians’ perceptions of clinical and social service integration and rates of acute and emergency healthcare utilization; and uses administrative data to quantify the effect of integrated housing supports on healthcare utilization among patients experiencing housing insecurity or homelessness.

(K01) 
PI: Ann M. Nguyen 
Organization:  Rutgers Biomedical and Health Sciences 
Grant Start Date: April 1, 2024 
Develops and tests an evidence-based intervention to accelerate the implementation of integrated behavioral health in primary care by using leadership concepts to overcome organizational, attitudinal, and financial challenges. The study team identifies key implementation challenges as well as the leadership skills needed to successfully implement integrated behavioral health; develops an intervention based on the information collected; and then evaluates the preliminary effectiveness, feasibility, and acceptability of using the intervention in practice settings.

(R01) 
PI: Monica Perez Jolles 
Organization: University of Colorado – Denver 
Grant Start Date: September 30, 2024 
Evaluates the effectiveness of a system-level intervention designed to increase service referrals and follow-up to address the psychosocial needs of caregivers and children identified through primary care screenings (e.g., exposure to violence, racism, and insecure housing). The intervention being tested uses Process Service Mapping, a novel methodology that maps patients’ journeys to identify inequities, challenges, and action points to optimize service pathways.

Behavioral Approach to Treating Chronic Pain

One grant looked at a novel behavioral health approach for treating chronic pain.

(R01) 
PI: Thomas C. Chelimsky 
Organization: Virginia Commonwealth University  
Grant Start Date: September 30, 2022 
Looks at using a “biobehavioral” approach to treating chronic pain rather than a “biopharmacologic” approach. The biobehavioral approach treats chronic pain syndrome as a brain disorder that has been reinforced through negative cognitive, emotional, and behavioral habits. In a previous pilot study, the researchers demonstrated that primary care practitioners were eager to implement this new approach, and those who did so had increased confidence with chronic pain management, reduced visit times, and improved patient pain. The primary care practices in this study receive training from a paired psychologist and a physical therapist to build a clinical team. The study examines whether patient improvements can be sustained for 2 years and whether increased practitioner confidence leads to a tapering of prescribed opioids.

Initiatives and Resources

The Academy for Integrating Behavioral Health and Primary Care

������Ƶcontinues to host , which has several materials from 2023 and 2024, described below. There are also a number of other recent ������Ƶmaterials related to behavioral health and SUDs, including a change package to improve information and care for older adults related to opioid use and misuse and treating OUD and a webinar presenting AHRQ-funded research focused on behavioral health integration in primary care.

Compendium of Resources for Managing Unhealthy Alcohol Use

This (PDF, 10.8 MB) from the technical assistance and evaluation center for EvidenceNOW: Managing Unhealthy Alcohol Use includes a compendium (Appendix III) of nearly 600 tools and resources for diagnosing and treating unhealthy alcohol use from The Academy for Integrating Behavioral Health and Primary Care’s . 

Pharmacotherapy for Adults with Alcohol Use Disorder in Outpatient Settings: Systematic Review

This from the Effective Healthcare Program updates a report on pharmacotherapy for treating alcohol use disorder.

Opioid Use in Older Adults: Compendium of Resources

This change package is designed to help primary care practices and healthcare systems improve opioid medication management and prevent opioid misuse and opioid use disorder in older adults. The change package includes: 

• An interactive compendium that links to recommended activities and tools and resources, organized by seven key areas in which change may be needed, called high-leverage changes and change strategies.
• A self-assessment that can be used by practices to determine which of the high-leverage changes are their highest priority and which they have the capacity to address. Self-assessment materials include:
  • Practice Self-Assessment Tool for Opioid Use in Older Adults (PDF, 1.3 MB).
  • How to Complete the Practice Self-Assessment Tool (PDF, 371 KB).
• Five case studies describing how primary care practices implemented a quality improvement project using tools from the compendium and their lessons learned:
  • Using an Electronic Health Record System to Prevent Opioid Use Disorder in Older Adults in Primary Care Practices Case Study (PDF, 880 KB).
  • Creating a Work-Around to Implement Fall Risk Screening for Older Adults Using Appointment Notes Case Study (PDF, 414 KB).
  • Implementing Opioid Risk Screening for Older Adults Using Automated Patient Reminders in an Electronic Health Record Case Study (PDF, 218 KB).
  • New Clinical Processes and Improving Workflows for Opioid Management in a Geriatric Clinic: Using Input from The Team Case Study (PDF, 225 KB).
  • Supporting Clinical Staff Who Prescribe Opioids to Older Adults: Providing Targeted Educational Sessions to Meet Needs Case Study (PDF, 737 KB).

NCEPCR Webinar: Research on the Integration of Behavioral Health in Primary Care 

NCEPCR hosted a webinar in March 2024 to highlight research focused on the integration of behavioral health in primary care. The webinar included two ������Ƶgrantees who presented on their work researching behavioral health tools and interventions in ambulatory care settings. In addition, the webinar included a presentation on The Academy for Integrating Behavioral Health and Primary Care, AHRQ's national resource for integrating behavioral health and primary care.

The website serves as a centralized portal for sharing information and materials on behavioral health integration. The portal includes several primary care-relevant materials released in 2023 and 2024, including the following Topic Briefs: 

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